New treatment pathway offers more opportunities for bladder cancer patients

A new treatment pathway to give patients a fighting chance against bladder cancer has been developed at Monash Health. 

Alex McEwan was diagnosed with bladder cancer in 2021 and is one of two patients who have received this treatment at Monash Health and one of the first to have this treatment in Victoria. 

While he quickly began treatment after his diagnosis in April of that year, the standard treatment for bladder cancer did not work for Alex. 

“I was more worried that if I didn’t get something else that worked, I would be in real trouble,” Mr McEwan said.  

The usual medication used to treat bladder cancer is the Bacillus Calmette-Guerin vaccine (BCG), which is administered right into a patient’s bladder to reduce the risk of cancer progressing into the muscle layers of the bladder or spreading outside of the bladder. 

Unfortunately, in about 30% to 50% of patients, BCG treatment doesn’t work, and often the only remaining treatment option for these patients is a cystectomy, the removal of the urinary bladder.  

However, for patients who are not well enough for a cystectomy or for those who choose not to have the procedure, further treatment options are limited or nonexistent in Australia. But now, a new treatment protocol is giving bladder cancer patients more alternatives for treatment.  

Importing a new treatment used internationally 

Dr Weranja Ranasinghe, a Urologist and Uro-Oncologic Surgeon at Monash Health, recognised the difficult decision that patients were facing, and began work with a dedicated team to make a new treatment available for patients.  

While undertaking a urologic oncology fellowship in the United States, Dr Ranasinghe gained experience using the combination chemotherapy medicines, gemcitabine and docetaxel (Gem-Doce), to treat bladder cancer. 

“Gem-Doce are established chemotherapy medicines and administering them sequentially into the bladder is shown to be effective in about 60 to 69% of patients who don’t respond to BCG treatment or those who wish for bladder preservation,” said Dr Ranasinghe.  

Gem-Doce treatment for bladder cancer has been used internationally, especially in the United States. However, chemotherapy using Gem-Doce had not been made available to bladder cancer patients in Victoria as part of any existing treatment programs. 

On my return to Monash Health, I realised that there were limited options for patients who don’t respond to BCG treatment, which led us to set up this new program at Monash Health,” said Dr Ranasinghe.  

The new treatment combines these two chemotherapy medicines, Gem-Doce, and is delivered as an intravesical treatment, which is administered into the bladder. When successful, it provides a new treatment option for bladder cancer patients. 

The treatment is administered for the first time 

After it was found that there was still cancer present in Alex’s bladder following two BCG treatments, Dr Ranasinghe approached Alex to see if he was willing to try the new chemotherapy program which utilised the Gem-Doce medicines.  

Dr Ranasinghe said, “I explained to him that he would be the first patient at our institution and possibly in Victoria to receive this treatment. We spoke about the risks and benefits, and that for some patients, the treatment may not work.” 

Alex, however, had no hesitations in agreeing to the new treatment. 

Alex completed six weeks of the initial treatment, and after a check-up cystoscopy at the beginning of 2022, his bladder was clear of cancer. He has now completed three weeks of maintenance treatment and is extremely happy with the results of this treatment.  

“I’m very glad it worked for me, and I hope it works for a lot of other people who are in a similar situation. From my experience, there is nothing that I can think of to fear this new treatment.  

“This treatment has changed the whole protocol for the treatment of bladder cancer, and I’m pleased about that,” said Mr McEwan. 

Jincy Kuriakose is a Clinical Nurse Specialist in the Urology department at Moorabbin Hospital and cared for Alex as he received his treatment.  

“Alex understood the possible risks after I told him that we were doing this treatment for the first time, but he trusted me because I treated him during his BCG treatment, and we gained a good relationship,” Ms Kuriakose said.  

Ms Kuriakose was instrumental in developing the protocol at Monash Health for the Gem-Doce bladder cancer treatment and completed the research based on additional protocols from overseas.  

“This can be the treatment of choice for patients who cannot have BCG treatment for various reasons such as not being able to tolerate the treatment due to the irritating symptoms. This treatment can also be for patients, like Alex, who still have bladder cancer recurrences after BCG treatment but are not fit for a cystectomy,” she said.  

A combined clinical effort provides great outcomes 

The development of this new treatment relied on effective cross-unit collaboration, which involved support from the Monash Health Pharmacy team.

Obaid Fazli, Assistant Deputy Director of Pharmacy, explained that the new treatment involves instillations of two different chemotherapies, gemcitabine followed immediately by docetaxel, into the bladder. The chemotherapy is prepared in a fully encapsulated syringe to ensure it can be safely administered into the bladder without any risk of exposure to healthcare personnel involved in the administration.

With evidence that the new treatment can help patients like Alex, the Urology team at Monash Health has now developed and established a formalised Gem-Doce program to ensure more bladder cancer patients are provided access to these potentially game-changing treatment.